Affiliations: [a] Department of Neurology, University of Schleswig Holstein, Kiel Campus, Germany | [b] Department of Clinical Neurophysiology, Beaumont Hospital, Dublin, Ireland | Wake Forest University, Department of Neurology, Program in Rehabilitation, Winston Salem, NC, USA
Correspondence:
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Address for correspondence: Kirsten Zeuner, MD, Department of Neurology, University of Schleswig-Holstein, Kiel Campus, Neurozentrum, Schittenhelmstrasse 10, 24105 Kiel, Germany. E-mail: k.zeuner@neurologie.uni-kiel.de
Abstract: Dystonia is a disabling movement disorder, which is characterized by an abnormal pattern of muscle activity with co-contraction of agonist and antagonist muscles. In the case of focal hand dystonia (FHD), these abnormal movements affect muscles of the forearm and hand while performing a specific task. Patients may initially present with dystonic symptoms occurring with a selective task (simple writer's cramp or musician's cramp), and may progress to develop symptoms with multiple tasks (dystonic writer's cramp). The underlying cause of this disabling condition remains unclear. This review examines recent studies designed to further elucidate the underlying pathophysiological processes in focal dystonia. Animal research work, and neurophysiological and neuroimaging studies in humans, have identified several possible mechanisms that may contribute to the underlying pathophysiology, including impaired sensorimotor integration, motor cortex activation and surround inhibition. Pharmacological treatment for dystonia is currently suboptimal. Based on these recent pathophysiological findings, several promising and novel non-pharmacological treatment modalities have recently been developed. Attempts at modulating impaired sensorimotor integration and cortical inhibition using sensorimotor retraining, and the range of sensory training techniques recently described, are further discussed in this review.
Keywords: Focal hand dystonia, sensory training, motor training, abnormal reorganization, maladaptive plasticity
